Need expert advice on how to pass 39 patients' medication in a 2-hour time frame.

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Situation: I'm working in a skilled nursing facility and the unit/station I'm in charge of has 39 residents. For AM shifts, all 39 residents have scheduled medications due at 9am. We are using electronic medical records so we are allow to give medication from 8am to 10am, all medication given after 10am will be considered as late.

Problem: the management kept on reminding me that I need to pick up my speed, they don't want my med pass to be late.

So am I lacking a certain skill or is there something essential that I didn't learn from nursing school? If anyone actually bother to do this simple math, to get through 39 patients in 2 hours that's 3 minutes per patient. THREE MINUTES PER PATIENT. Each patient has an average of 8+ medications need to be given. On top of that, 2/3 of the patients requires BP and/or apical pulse check before med administration. Furthermore, because it's a SNF, we get mostly geriatric patients, so these patients need time to take their medication. So yea, if any of you are working or has worked at a SNF with similar situation, I will really appreciate it if you could share your experience on how to handle this.

Specializes in ICU, CM, Geriatrics, Management.
... machine-gun style Pyxis machine... Maybe get someone to go through and get the orders changed so that one end of the hall's residents' meds are ordered for 8am and the other end of the hall's meds are ordered for 10am...

Hahahaha!

Like your idea for the timing change.

Im now working on very busy LTC floor, I have 20 patients and the morning med pass takes me three hours most days. I have no Idea how you could possibly get that done. I also consider myself "quick" compared to other nurses I have worked with. Half my patients I have to spoon feed each pill and wait for them to drink and swallow, some of them have over 15 pills in the morning. I honestly have anxiety for you just thinking about having to pass meds for that many people! Good luck to you!

Specializes in LTC, assisted living, med-surg, psych.

I think med passes would go so much better if doctors and families weren't so fond of feeding residents supplements. Honestly, when you've got someone with advanced dementia and swallowing issues, why do they need a multi AND Vitamins B12, B-complex, C, D, and E? Not to mention those huge calcium tablets and iron, four different stool softeners, cranberry tablets, even saw palmetto......why, it's absurd.

skip the Ca++, keep the rest...the cranberry and the saw palmetto's reason would be for comfort. the others more well known...I would prefer they skip pharmaceuticals...

I think med passes would go so much better if doctors and families weren't so fond of feeding residents supplements. Honestly, when you've got someone with advanced dementia and swallowing issues, why do they need a multi AND Vitamins B12, B-complex, C, D, and E? Not to mention those huge calcium tablets and iron, four different stool softeners, cranberry tablets, even saw palmetto......why, it's absurd.
Specializes in LTC, Correctional Nursing.

Good luck... with me 30 residents (give or take a few) with med pass at 9 & 1 as well as accu-checks at 11 using a paper MAR not to mention the countless non emergency calls from the ward clerk is enough to make me pull my hair out. It is almost impossible to do your job efficiently and still have time to pee most days.

Specializes in HH, Peds, Rehab, Clinical.

I'd pull my hair out. I can think of only ONE person I have to spoon feed pill to and she only has 2 on my med pass. I make it three because one is a huge Ca pill that I break in half. I have one short term resident (I'm on rehab, most are short term) who has at LEAST 15 pills at HS and many are big. She would put any college kid to shame that way she fires them back like a Jagger shooter! I can't watch her or I'll gag, LOL

Im now working on very busy LTC floor, I have 20 patients and the morning med pass takes me three hours most days. I have no Idea how you could possibly get that done. I also consider myself "quick" compared to other nurses I have worked with. Half my patients I have to spoon feed each pill and wait for them to drink and swallow, some of them have over 15 pills in the morning. I honestly have anxiety for you just thinking about having to pass meds for that many people! Good luck to you!
Specializes in Med nurse in med-surg., float, HH, and PDN.

It's a hell of an ethical dilemma, I know; I was there once myself. I used to wonder how the other 'med' nurses (We had NO ward clerks) actually had time to do the med passes, CBG's, PRN's, phone calls, docs orders, INH changes, faxes, treatments, IV's, required charting, etc., etc., etc., and I would see them sitting around at the nurse's station chatting and joking, 'all done' with their day an hour before end of shift. Somebody was cutting corners somehow, and in a big way, IMHO. I lasted six months and was thrown under the bus. It was the most disgusting travesty I've experienced in my entire career. Hind-sight being 20/20, I should've quit after the first month. I kept thinking it was me, and if I only tried harder or knew some nifty 'tricks' I could conquer the problem. Well, it wasn't me. It was the facilities 'powers that be', and their ridiculous idea that their expectations were reasonable.

Specializes in ICU, CM, Geriatrics, Management.
... kept thinking it was me, and if I only tried harder or knew some nifty 'tricks' I could conquer the problem. Well, it wasn't me. It was the facilities 'powers that be', and their ridiculous idea that their expectations were reasonable.

So very right, No Stars.

And young nurses are told, "you'll get faster... you'll develop your own system -- give it time."

It's all bull, of course... because as time passes, even more is required.

Specializes in Med nurse in med-surg., float, HH, and PDN.
So very right, No Stars.

And young nurses are told, "you'll get faster... you'll develop your own system -- give it time."

It's all bull, of course... because as time passes, even more is required.

I was told I spent too much time with the patients, that the job was not one of patient care, per se. Good Lord! Why do most of us go into nursing? But they were right in that respect; your 'job' is taking care of the facility's BUSINESS. You suffer, trying to be efficient, because 'caring' is totally beside the point.

Specializes in ICU, CM, Geriatrics, Management.
I was told ... the job was not one of patient care, per se...

How ridiculous??? :yes:

Simply amazing what comes out of the mouth of some managers.

Update: It's been 4 months since I started to work at this SNF and it's still humanly impossible to finish all meds within the "correct" time frame. At this point I sincerely believe SNFs have nothing to do with patient care. For god's sake I have to bring in my own blood pressure cuffs because the ones in the facility can't even be inflated. I told the central supply to order some new ones and it took them almost TWO MONTHS to get that done due to "budget problem." Oh well, I guess it's about time to start job hunt again.

Specializes in Med nurse in med-surg., float, HH, and PDN.
Update: It's been 4 months since I started to work at this SNF and it's still humanly impossible to finish all meds within the "correct" time frame. At this point I sincerely believe SNFs have nothing to do with patient care. For god's sake I have to bring in my own blood pressure cuffs because the ones in the facility can't even be inflated. I told the central supply to order some new ones and it took them almost TWO MONTHS to get that done due to "budget problem." Oh well, I guess it's about time to start job hunt again.

When it is never possible to do the impossible, no matter how hard you try, it's time to bail out. NO job is worth what you have been trying to deal with. Take it from me, the voice of experience who had to find out the hard way.

Save your best intentions for a place that can appreciate you and your efforts.

And SAVE YOUR CAREER AND LICENSE!

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